A Case Report of a Malignant Insulinoma Abstract #2124

Introduction: Despite rare (1-2% of pancreatic tumors/PT), insulinomas are the most common functional pNET. The diagnosis is established by demonstrating inappropriately high serum insulin levels during a spontaneous or induced episode of hypoglycemia.
Aim(s): To present the clinical case of a woman with malignant insulinoma(MI).
Materials and methods: A 73y old woman with persistent abdominal pain & recurrent spontaneous hypoglycemic episodes,PS:2,was diagnosed with a well differentiated G2 pancreatic NEN (Ki67:15%,Syn+:100%,Chr+:<10%,Isl-1+:100%,PDX-1+:100%,ATRX retained,Ins-,NESP55-,SSTR2a+:sc.+3) & multiple liver mets. Fasting C-peptide & insulin were elevated: 5.6ng/ml, 33μU/ml respectively. Octreoscan showed abnormal uptake in the aforementioned lesions. The diagnosis of MI was confirmed (1st case among 386 pts with PT, consecutively admitted in Our Dept between 1/1/2006-31/8/2017) and started on temozolomide+capecitabine+Somatulin autogel. After 3 cycles, liver PD was documented with serious hypoglycemic episodes. There was no improvement of her PS. She received 2nd line 5FU+Oxaliplatine+diazoxide & 6 cycles later she experienced radiological SD. Nevertheless,her clinical status was not improved, apart from the discontinuation of the hypoglycemic episodes. C-peptide & insulin:11ng/ml & 23μU/ml. Due to unsatisfactory results she started Everolimus(E) 10mg/d.
Conference: 15th Annual ENETS conference 2018 (2018)
Category: Case reports
Presenting Author: Theodoros Tegos
Keywords: malignant, insulinoma

To read results and conclusion, please login ...

Further abstracts you may be interested in

#1257 A Clinicopathological Study of Malignant Insulinoma in a Contemporary Series
Introduction: Malignant insulinoma is traditionally considered extremely rare and its natural history variable.
Conference: 13th Annual ENETS conference 2016 (2016)
Category: Epidemiology/Natural history/Prognosis - Descriptive epidemiology
Presenting Author: Dr. Run Yu
#1390 Ectopic Malignant Insulinoma with Multiple Liver Metastases: A Case Report
Introduction: Malignant insulinoma arising from ectopic pancreas is very rare.
Conference: 13th Annual ENETS conference 2016 (2016)
Category: Clinical cases/reports
Presenting Author: Dr. Huang Ying Tan
Authors: Liu Q, Luo J, Li C, Zhu Z H, ...
#2249 Pasireotide as a Possible Tool for the Control of Refractory Hyperinsulinemic Hypoglycemia from Malignant Insulinoma
Introduction: The control of hypoglycemic hyperinsulinemic syndrome from malignant insulinoma is challenging because it is often refractory to diazoxide and somatostatin analogues (SA). Everolimus can have side effects that can limit its use. Pasireotide, a multi-receptor-targeted SA with a high binding affinity to SSTR1 and SSTR5, exhibits a strong inhibitory effect of insulin secretion.
Conference: 15th Annual ENETS conference 2018 (2018)
Category: Case reports
Presenting Author: MD Maria Vittoria Davì
#431 Everolimus Controlled Resistant Hypoglycemia in Malignant Insulinoma
Introduction: A pancreatic neuroendocrine carcinoma with liver metastases was diagnosed on July 2006 in a 65-year-old man. He was treated with octreotide LAR 30 mg for three years. At liver progression he was enrolled in a multicenter Italian trial titled “XELBEVOCT” with Bevacizumab + Metronomic Capecitabine + Octreotide LAR 30 mg. After seven months, the patient exhibited severe hypoglycemic syndrome with HGT serum levels<30 mg/dl, insulin 150 microUI/ml, and C-peptide at upper normal limits. Endocrinologist prescribed prednisone, diazoxide and recombinant glucagon for hypoglicemic crisis, with little benefit. In March 2010, the patient was given radio-labelled Lu-177-OCTREOTATE treatment. After three cycles, hypoglicemic symptoms were still uncontrolled. CT scan showed stable disease.
Conference: 9th Annual ENETS Conference (2012)
Category: Clinical
Presenting Author: Dr. Anna Ferrero
Authors: Ferrero A, Bellini E, Brizzi M P, Pia A, ...
#270 Insulinoma: A Rare Tumor?
Introduction: Insulinoma, a pancreatic ß-cell tumor, comprises 55% of neuroendocrine tumors with an annual incidence of 3-10/million. 10% are malignant, 10% are multiple and half of them present in MEN-1.
Conference: 8th Annual ENETS Conference (2011)
Category: Clinical
Presenting Author: Dr Vasiliki Daraki